Abstract: TH-PO1139
Embolization of Polycystic Kidneys as an Alternative to Nephrectomy Before Kidney Transplant
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Broseta, Enric, La Fe University Hospital, Valencia, Spain
- Gómez-Palomo, Francisco, La Fe University Hospital, Valencia, Spain
- Luján, Saturnino, La Fe University Hospital, Valencia, Spain
- Martinez-Rodrigo, Jose, University Hospital, Valencia, Spain
- Perez-Enguix, Daniel, University Hospital, Valencia, Spain
- Garcia-Marcos, Raul, University Hospital, Valencia, Spain
- Espí, Jordi, La Fe University Hospital, Valencia, Spain
- Boronat, Francisco, La Fe University Hospital, Valencia, Spain
Background
Autosomal dominant polycystic kidney disease (ADPKD) is responsible for progressive end-stage renal disease. In case of a massive enlargement of polycystic kidney, renal transplantation surgery may be hindered due to the limited pelvic space. In such cases a radical nephrectomy prior to renal trasplantation is warranted. Recently, transcatheter arterial embolization (TAE) has been described as an alternative to nephrectomy.
We prospectively evaluated the safety and efficacy on long-term kidney volume reduction of TAE procedures in a group or patients with ADPKD before renal transplantation.
Methods
Between January 2016 and December 2018, 16 patients with end-stage renal disease associated to massive ADPKD were prospectively recruited. Informed consent was obtained from all participants. All procedures were carried out according to the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration. All TAE were performed under local anesthesia and sedation and using cyanoacrylate as embolic agent. A previous CT scan and further CT at 6 and 12 months after TAE were performed. The variables collected were: age, gender, size, renal volume measured by volumetry before and after TAE and score on the visual analog scale (VAS) for pain and complications. A descriptive statistical analysis was made.
Results
A total of 16 patients (9 men and 7 women) were included. The average age was 52.38 (± 9.19) years. The average hospital stay was 3.71 (± 1.32) days. 11 patients presented with mild complications (Clavien-Dindo I). The average score on the VAS scale was 3.38 (± 2.46) points. Only one patient presented a partial embolization of the renal artery, which was resolved by a new TAE with cyanoacrylate and a coil.
Before embolization average kidney volume was 2509.08 ± 946.7 cc. Six months later volume was 1303.71 ± 836.2 cc. and 12 months later 1098.41 ± 684.9 cc. During the first 6 months a reduction of 48.05% in renal volume was observed. Of these patients, 9 (56.25%) have received a kidney transplant without problem of space.
Conclusion
Our results indicate that TAE is a safe and effective alternative to nephrectomy before renal transplantation in patients with ADPKD .